Pink Eye

Dear Lisa,

How can I tell if my son has pink eye? His eyes are red but he has been swimming in the pool a lot. How can I tell if my son’s eyes are red from the pool or from pink eye?

“Red eyes”

Dear “Red eyes”,

The term “Pink Eye” is a general term that describes the condition of the sclera (white part of the eye). When a person has "Pink Eye" their sclera turns pink due to the dilation of the blood vessels in the eye. This redness is a symptom that can represent many different diseases. Conjunctivitis or the inflammation of the conjunctiva is one of the most common causes of “pink eye”. (2) Conjunctivitis may be due to a virus, bacteria, allergy or irritation.

Therefore a child’s eye may appear red or pink for a variety of reasons. A child with itchy, red eyes may have Allergic Conjunctivitis due to allergies. Watery, red eyes may be caused by a virus. If a child with eye pain keeps his eye closed shut or covers his eye with his hand it is likely that he has an injury or corneal abrasion. (1) Red eyes and blurred vision may represent a drug reaction or Blepharitis. (1)

"Pink Eye" due to Bacterial Conjunctivitis is the type of "Pink Eye" that concerns most parents because it is contagious. Bacterial Conjunctivitis is due to a bacterial infection which causes crusting on the eyelashes, thick eye discharge that sticks to the eyelashes and matting of the eyelids. It is common for a child with Bacterial Conjunctivitis to wake in the morning with his eyes sealed shut. Other symptoms of Bacterial Conjunctivitis include burning, discomfort, blurred vision due to the purulent discharge and injected sclera (the white part of the eye turns red). (3,4) Young children may not be able to tell you that their eye hurts or that they have blurred vision. Instead, many times they present with irritability and fussiness.

If your child has signs of Bacterial Conjunctivitis he should be seen by a health care professional so that treatment with antibiotic eye drops or ointment can be started. Implementing treatment quickly may prevent spreading of the infection and allow the child to return to his regular activities. (3). Conjunctivitis can be spread by direct contact with the infected eye or through contamination of the hands. Once the organism gets on the hand it is spread to the eyes by accidental touching or rubbing of the eyes. (5) A child with Pink Eye can continue to spread the germs for 24 to 48 hours after therapy begins. (2)

Since Conjunctivitis can easily be spread from one eye to the next and from one person to the next meticulous hand washing is necessary in order to contain the disease. (2) I recommend that a parent use a wet paper towel to wash the face and hands of a child with Conjunctivitis. This way the towel can be discarded immediately after use which cuts down on the chance of accidentally spreading the infection to other members of the household. It is also a good idea to wash the child’s pillowcase and the toys that a child plays with.

Once a child with conjunctivitis is treated you should see some resolution in symptoms within 48 to 72 hours. (4, 5) If the symptoms persist beyond this period your child should be checked by a healthcare professional. (4) Persistence of symptoms may represent a different problem such as Herpes infection, Blepharitis, Lice infestation on the eyelashes, Molluscum Contagiosum on the eyelids or Conjunctivitis-Otitis Syndrome.

It is common for young children to develop Otitis Media (middle ear infection) along with Conjunctivitis. (2) This tends to occur in younger children and many times is associated with a fever. Fever occurs in 40 to 50% of children with Conjunctivitis-Otitis Syndrome. (2) If a child has a fever along with “Pink Eye”, it is important to have him evaluated by his Physician or Nurse Practitioner to determine the cause. A persistent fever accompanying “Pink Eye” may also represent a more serious condition such as Kawasaki syndrome. (7)

It is common for children to develop red eyes after swimming in a chlorinated pool because the chlorine is an irritant to the eyes. If your child complains of pain and excess tearing along with red eyes after swimming in a pool or playing outdoors in the sun, it is important to have him evaluated. Exposure to excessive chlorine in swimming pools, excessive sunlight, aerosol sprays and other noxious gases can cause diffuse superficial punctuate corneal abrasions that are painful. This condition needs to be treated by a Physician.

(1) Morrow GL, Abbott RL. Conjunctivitis. Am Fam Physician. 1998:57735-746.
(2)Pichichero ME. Co-Infections of Conjunctivitis. Infectious Disease in Children. 2003. March;(S6-7).
(3)Brunnel P. Bacterial Conjunctivitis in Children: Containing the Infection. Infectious Diseases in Children. 2006; Jan:(S3-4).
(4) Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc 1990: 323.
(5) American Academy of Pediatrics. Infections Spread by Direct Contact. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:96-97.
(6)Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:331-336.(2)Pichichero ME. Co-Infections of Conjunctivitis. Infectious Disease in Children. 2003. March; (S6-7).
(7)American Academy of Pediatrics. Kawasaki Syndrome. In: Pickering L.K. ed. Red Book: 2003. Report of the Committee on Infectious Disease. 26th ed. Elk Grove Village. IL: American Academy of Pediatrics; 2003: 392.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Childhood Infections